
Have you joined our BOTOX CLUB yet?
OUR BOTOX CLUB IS HANDS-DOWN THE BEST WAY TO SAVE HUNDREDS ON BOTOX IF YOU RECEIVE REGULAR SESSIONS.
When you become a member of our exclusive club, you’ll get to enjoy discounts on Botox all year long!

BOTOX CLUB ORIGINAL
Botox at $16.50/unit
(40 units, 4 x per year)
$2640
INCLUDES A $50 VOUCHER
TOWARD ANY FACIAL

GLOWTOX CLUB
Botox at $14.00/unit
(40 units, 4 x per year) + series of 3 VI peels
$3065
INCLUDES A $100 VOUCHER
TOWARD ANY FACIAL SERVICE + 15% OFF FACIAL PRODUCTS ALL YEAR LONG
WELCOME TO OUR BOTOX CLUB!
As a member, you receive special pricing for Botox all year! Plus one complimentary facial a year.
The following lists the terms of conditions of our Botox Club. Please read carefully and initial at each line, and feel free to ask any questions.
– I understand that NO REFUNDS or services beyond contract dates are allowed under any circumstance.
– I understand that my membership benefits CANNOT be shared, and do not accrue. Discounts and facial are non-transferrable, and facial does not “roll over” to the following year if unused. I must use the units purchased in a 12 month period.
(Requires a minimum of 40 units per tx.)
By signing below, I indicate understanding of the Botox Club benefits, and the terms and conditions that apply. In addition, I hereby authorize Deborah Longwill DO PA to charge the card listed below for the membership fee.

Botox Consent Form
Please fill out the Botox Membership & Authorization Consent Form

Have you joined our BOTOX CLUB yet?
OUR BOTOX CLUB IS HANDS-DOWN THE BEST WAY TO SAVE HUNDREDS ON BOTOX IF YOU RECEIVE REGULAR SESSIONS.
When you become a member of our exclusive club, you’ll get to enjoy discounts on Botox all year long!

BOTOX CLUB ORIGINAL
Botox at $16.50/unit
(40 units, 4 x per year)
$2640
INCLUDES A $50 VOUCHER
TOWARD ANY FACIAL

GLOWTOX CLUB
Botox at $14.00/unit
(40 units, 4 x per year) + series of 3 VI peels
$3065
INCLUDES A $100 VOUCHER
TOWARD ANY FACIAL SERVICE + 15% OFF FACIAL PRODUCTS ALL YEAR LONG
WELCOME TO OUR BOTOX CLUB!
As a member, you receive special pricing for Botox all year! Plus one complimentary facial a year.
The following lists the terms of conditions of our Botox Club. Please read carefully and initial at each line, and feel free to ask any questions.
– I understand that NO REFUNDS or services beyond contract dates are allowed under any circumstance.
– I understand that my membership benefits CANNOT be shared, and do not accrue. Discounts and facial are non-transferrable, and facial does not “roll over” to the following year if unused. I must use the units purchased in a 12 month period.
(Requires a minimum of 40 units per tx.)
By signing below, I indicate understanding of the Botox Club benefits, and the terms and conditions that apply. In addition, I hereby authorize Deborah Longwill DO PA to charge the card listed below for the membership fee.

Botox Consent Form
Please fill out the Botox Membership & Authorization Consent Form